Artificial facet joint

ABSTRACT

Various methods and devices for replacing damaged, injured, diseased, or otherwise unhealthy posterior elements, such as the facet joints, the lamina, the posterior ligaments, and/or other features of a patient&#39;s spinal column, are provided. In one exemplary embodiment, the methods and devices are effective to mimic the natural function of the spine by allowing flexion, extension, and lateral bending of the spine, while substantially restricting posterior-anterior shear and rotation of the spine.

FIELD OF THE INVENTION

The present invention relates to spinal instrumentation, and inparticular to various devices that are adapted to mimic the naturalfunction of the structural posterior elements.

BACKGROUND OF THE INVENTION

The vertebrae in a patient's spinal column are linked to one another bythe disc and the facet joints, which control movement of the vertebraerelative to one another. Each vertebra has a pair of articulatingsurfaces located on the left side, and a pair of articulating surfaceslocated on the right side, and each pair includes a superior articularsurface, which faces upward, and an inferior articular surface, whichfaces downward. Together the superior and inferior articular surfaces ofadjacent vertebra form a facet joint. Facet joints are synovial joints,which means that each joint is surrounded by a capsule of connectivetissue and produces a fluid to nourish and lubricate the joint. Thejoint surfaces are coated with cartilage allowing the joints to move orarticulate relative to one another.

Diseased, degenerated, impaired, or otherwise painful facet jointsand/or discs can require surgery to restore function to the three jointcomplex. Subsequent surgery may also be required after a laminectomy, asa laminectomy predisposes the patient to instability and may lead topost-laminectomy kyphosis (abnormal forward curvature of the spine),pain, and neurological dysfunction. Damaged, diseased levels in thespine were traditionally fused to one another. While such a techniquemay relieve pain, it effectively prevents motion between at least twovertebrae. As a result, additional stress may be applied to theadjoining levels, thereby potentially leading to further damage.

More recently, techniques have been developed to restore normal functionto the facet joints. One such technique involves covering the facetjoint with a cap to preserve the bony and articular structure. Cappingtechniques, however, are limited in use as they will not remove thesource of the pain in osteoarthritic joints. Caps are alsodisadvantageous as they must be available in a variety of sizes andshapes to accommodate the wide variability in the anatomical morphologyof the facets. Caps also have a tendency to loosen over time,potentially resulting in additional damage to the joint and/or the bonesupport structure containing the cap.

Other techniques for restoring the normal function to the posteriorelement involve arch replacement, in which superior and inferiorprosthetic arches are implanted to extend across the vertebra. Thearches may have rigid surfaces that can articulate relative to oneanother to replace the articulating function of the facet joints.However, aligning two articulating rigid surfaces for facet replacementscan be very difficult given the variations in patient anatomy andvarious motion required (i.e., flexion, extension, lateral bending, andtranslations).

Accordingly, there remains a need for improved systems and methods thatare adapted to mimic the natural function of the facet joints.

BRIEF SUMMARY OF THE INVENTION

The present invention provides various methods and devices for repairingand/or replacing a damaged facet joint, and optionally for replacingother posterior elements, including, for example, the lamina, theposterior ligaments, and/or other features of a patient's spinal column.In one exemplary embodiment, an implantable device for replacing and/orstabilizing one or more facet joints in a patient's spinal column isprovided and it generally includes a first member that is adapted tocouple to a first vertebra and having a bearing element rotatablydisposed therein with an opening formed therethrough, and a secondmember that is adapted to couple to a second vertebra adjacent to thefirst vertebra. The second member can include an extension rod that isadapted to extend through the opening formed in the bearing element tocontrol movement between the first and second vertebrae.

While the first and second members can have a variety of configurations,in one exemplary embodiment the first member can be substantiallyU-shaped with opposed arms extending from a central portion, and thesecond member can be substantially Y-shaped with opposed arms extendingfrom a terminal end of the extension rod. In use, each arm on the firstand second members can be adapted to be received within a receiving headof a bone engaging element, such as a bone screw, to attach each arm toa vertebra. The device can also include at least one compressive elementpositioned between the central portion of the first member and thecentral portion of the second member, and at least one compressiveelement positioned between the central portion of the second member anda terminal end of the extension rod. The compressive element(s) can beadapted to facilitate controlled movement of the adjacent vertebrae.

The bearing element can also have a variety of configurations, but inone exemplary embodiment the bearing element can be a ball bearinghaving an opening formed therethrough. The opening formed through thebearing element can include a coating formed thereon that is adapted toreduce friction between the bearing element and the extension rod. Thebearing element can also be disposed at various locations on the firstmember, but in one exemplary embodiment the bearing element can befreely rotatably disposed within the central portion of the firstmember. In particular, the central portion can include a substantiallyspherical opening formed therein for rotatably seating the bearingelement.

In another embodiment of the invention, the extension rod can include atleast one stop member formed thereon and adapted to limit slidablemovement of the extension rod relative to the bearing element. Forexample, the extension rod can include first and second stop membersformed on first and second terminal ends thereof. The stop member(s) canhave a variety of configurations, and it can be formed from a variety ofmaterials including, for example, a compressive material. In oneembodiment, the stop member(s) can be in the form of a ring-shapedmember that is disposed around the extension rod. An exemplaryring-shaped member has a diameter that is greater than a diameter of theopening in the bearing element.

In yet another embodiment, the first member can be substantiallyL-shaped with a first portion that is adapted to mate to a bone engagingelement, and a second portion having the bearing element rotatablydisposed therein. The first portion of the first member can include anopening formed therein for receiving a portion of a locking mechanismadapted to couple the first portion of the first member to a boneengaging element. The first portion of the first member can also includean articulating surface formed thereon and that is adapted to bereceived within a complementary surface formed on a bone engagingelement. In one exemplary embodiment, the articulating surface can besubstantially spherical.

In another exemplary embodiment, the second member can be asubstantially elongate member having a first portion that is adapted tomate to a bone engaging element and a second portion that is adapted tobe disposed through the bearing element. The first and second portionsof the second member can be axially offset from one another. The secondmember can also include a stop formed thereon between the first andsecond portions. The stop can be adapted to limit movement of the secondportion relative to the bearing.

One exemplary method for stabilizing the posterior element in adjacentvertebrae is also provided. The method can include coupling a firstmember to a first vertebra and a second member to a second vertebra suchthat an extension rod on the first member extends through a bearingelement rotatably disposed within the second member to control movementof the first and second vertebrae relative to one another. The methodcan also include positioning the extension rod at a predetermined anglerelative to a central axis of the first and second vertebrae.

In one exemplary embodiment, the first member can be coupled to thefirst vertebra by implanting first and second bone engaging members inthe first vertebra and mating a portion of the first member to the firstand second bone engaging members, and the second member can be coupledto the second vertebra by implanting first and second bone engagingmembers in the second vertebra and mating a portion of the second memberto the first and second bone engaging members. The first and second boneengaging members can be implanted an opposed lateral sides of eachvertebra.

In another exemplary embodiment, the first member can be coupled to thefirst vertebra by implanting a bone engaging member in the firstvertebra and mating a portion of the first member to the bone engagingmember, and the second member can be coupled to the second vertebra byimplanting a bone engaging member in the second vertebra and mating aportion of the second member to the bone engaging member.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is perspective view of two exemplary posterior stabilizingimplants coupled to adjacent vertebrae;

FIG. 1B is a side view of one of the posterior stabilizing implantsshown in FIG. 1A coupled to adjacent vertebrae;

FIG. 2A is a side view of a first member of one of the exemplaryimplants shown in FIG. 1A;

FIG. 2B is a perspective view of one exemplary embodiment of a bonescrew and a locking mechanism for use with the first member shown inFIG. 2A;

FIG. 3 is a side view of a second member of one of the exemplaryimplants shown in FIG. 1A;

FIG. 4A is a side view of one of the posterior stabilizing implantsshown in FIG. 1A showing the adjacent vertebrae in a neutral position;

FIG. 4B is a side view of one of the posterior stabilizing implantsshown in FIG. 1A showing extension of the adjacent vertebrae;

FIG. 4C is a side view of one of the posterior stabilizing implantsshown in FIG. 1A showing flexion of the adjacent vertebrae

FIG. 5A is a perspective view of another exemplary embodiment of aposterior stabilizing implant coupled to adjacent vertebrae;

FIG. 5B is a side view of the posterior stabilizing implant shown inFIG. 5A;

FIG. 6 is a side view of a first member of the exemplary implant shownin FIG. 5A;

FIG. 7 is a side view of a second member of the exemplary implant shownin FIG. 5A;

FIG. 8A is a side view of the posterior stabilizing implant shown inFIG. 5A showing the adjacent vertebrae in a neutral position;

FIG. 8B is a side view of the posterior stabilizing implant shown inFIG. 5A showing extension of the adjacent vertebrae; and

FIG. 8C is a side view of the posterior stabilizing implant shown inFIG. 5A showing flexion of the adjacent vertebrae.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides various methods and devices for replacingdamaged, injured, diseased, or otherwise unhealthy posterior elements,such as the facet joints, the lamina, the posterior ligaments, and/orother features of a patient's spinal column. In one exemplaryembodiment, the methods and devices are effective to mimic the naturalfunction of the spine by allowing flexion, extension, and lateralbending of the spine, while substantially restricting posterior-anteriorshear and rotation of the spine. A person skilled in the art willappreciate that, while the methods and devices are especially configuredfor use in restoring and/or replacing the facet joints and optionallyother posterior elements of a patient's spine, the methods and devicescan be used for a variety of other purposes in a variety of othersurgical procedures.

FIGS. 1A-4C illustrate one exemplary embodiment of a posteriorstabilizing implant. While two implants 10, 10′ are shown coupled toopposed lateral sides of two adjacent vertebrae 60 s, 60 i, only oneimplant 10 will be discussed herein. A person skilled in the art willunderstand that the implants 10, 10′ can have substantially the sameconfiguration. Moreover, while only two implants 10, 10′ are shown,additional implants can be coupled to additional vertebrae located alongthe patient's spinal column. FIGS. 1A-1B also illustrate an artificialdisc/implanted between the adjacent vertebrae 60 s, 60 i. A personskilled in the art will appreciate that the posterior stabilizingimplants disclosed herein can be used with a natural disc or with anartificial disc. In an exemplary embodiment, where an artificial disc isused, the disc is preferably one which allows movement of the adjacentvertebrae 60 s, 60 i relative to one another. By way of non-limitingexample, one exemplary artificial disc for use with the presentinvention is the Charité™ Artificial Disc available from DePuy Spine,Inc.

As shown in FIGS. 1A-1B, the implant 10 can include a first member 20that is coupled to a first vertebra, e.g., the inferior vertebra 60 i,and a second member 30 that is coupled to a second vertebra, e.g., thesuperior vertebra 60 s. While not shown, the first and second members20, 30 can be reversed such that the first member 20 is coupled to thesuperior vertebra 60 s and the second member 30 is coupled to theinferior vertebra 60 i. The first and second members 20, 30 can also bemovably coupled to one another. In particular, the first member 20 caninclude a bearing element 22 movably disposed therein, and the secondmember 30 can include an extension rod 32 that is adapted to slidablyextend through the bearing element 22. In use, the bearing element 22and the extension rod 32 cooperate to control movement of the superiorand inferior vertebrae 60 s, 60 i relative to one another, and inparticular they allow flexion, extension, and lateral bending of thevertebrae 60 s, 60 i, while substantially restricting posterior-anteriorshear and rotation of the vertebrae 60 s, 60 i.

The first member 20 of the implant 10, which is shown in more detail inFIG. 2A, can have a variety of configurations. In the illustratedexemplary embodiment, however, the first member 20 is substantiallyL-shaped and it includes a first portion 20 a that is adapted to mate toa vertebra, e.g., the inferior vertebra 60 i, and a second portion 20 bhaving the bearing element 22 disposed therein. The exemplary first andsecond portions 20 a, 20 b each have a substantially planarconfiguration, and each portion 20 a, 20 b can be positioned at an anglerelative to one another. For example, the first and second portions 20a, 20 b can be substantially perpendicular to one another. Theconfiguration of each portion 20 a, 20 b relative to one another can,however, vary depending on the intended use.

As noted above, the first portion 20 a is adapted to mate to a vertebra.While various techniques can be used to allow the first portion 20 a tomate to a vertebra, in the illustrated exemplary embodiment the firstportion 20 a includes an opening 24 extending therethrough for receivinga portion of a fastening element and/or a bone engaging element. Theopening 24 can vary in shape and size depending on the type of boneengaging element and fastening element being used. In an exemplaryembodiment, as shown in FIG. 2B, the bone engaging element is a bonescrew 50 and the fastening element is a locking nut 52 that is adaptedto engage the bone screw 50 to lock the first portion 20 a of the firstelement 20 relative to the vertebra 60 i. In particular, the bone screw50 has a threaded shank 50 a that is adapted to extend into the vertebra60 i, a receiving head 50 b formed on the threaded shank 50 a, and athreaded central shaft 50 c that extends from the receiving head 50 bthrough the opening 24 in the first portion 20 a and that mates to thelocking nut 52. In one exemplary embodiment the receiving head 50 b canhave a shape that is configured to seat a posterior surface orarticulating surface 26 of the first portion 20 a of the first member 20such that a position of the first member 20 relative to the bone screw50 can be adjusted. For example, the receiving head 50 b can include asubstantially spherical recess 51 formed therein, and the articulatingsurface 26 of the first portion 20 a of the first member 20 can besubstantially spherical, as shown in FIG. 2A. As a result, the firstmember 20 can be angularly adjustable relative to the bone screw 50, andin particular relative to the vertebra 60 i. Such a configuration allowsthe bearing element 22 of the second portion 20 b of the first member 20to be positioned as desired, as will be discussed in more detail below.

The second portion 20 b of the first member 20 can also have a varietyof configurations, but as noted above the exemplary second portion 20 bincludes a bearing element 22 disposed therein for receiving theextension rod 32 on the second member 30. Various bearing elements 22known in the art can be used, but in the illustrated embodiment thebearing element 22 is a standard ball bearing that includes an opening22 i formed therethrough. The bearing element 22 can be disposed withinthe second portion 20 b of the first member 20 using a variety oftechniques, but in an exemplary embodiment the bearing element 22 ispreferably freely rotatable relative to the second portion 20 b of thefirst member 20. This will allow the bearing element 22 to pivot/rotateas the first and second members 20, 22 move relative to one another as aresult of movement of the vertebrae 60 s, 60 i relative to one another.As shown in FIG. 2A, the bearing element 22 is disposed within aspherical recess 28 that is formed within and extends through an insert27, and the insert 27 in turn is disposed within an opening 25 formed inthe second portion 20 b. A person skilled in the art will understandthat the bearing element 22 can be directly disposed within a recessformed within the second portion 20 b, and the use of an insert 27 isnot necessary.

In order to facilitate free rotation/movement of the bearing element 22within the recess 28, the bearing element 22 and/or the recess 28 caninclude a coating to reduce friction and reduce wear. The opening 22 iin the bearing element 22 can also include a coating formed therein toreduce friction and wear on the bearing element 22 caused by movement ofthe extension rod 32 therethrough. Suitable exemplary materials forcoating the bearing element 22, the recess 28, and/or the extension rod32 include, by way of non-limiting example, titanium nitrite coating,titanium carbon-nitrite coating, diamond-like carbon coating, and othersimilar materials. The bearing element 22, the recess 28, and/or theextension rod 32, which will be discussed in more detail below, can alsobe formed from certain materials that are adapted to withstand wear,such as, for example, stainless steel, titanium, cobalt chrome, plasticssuch as polyethylene and polyurethane, and various ceramics.

The second member 30 of the implant 10 can also have a variety ofconfigurations, but in one exemplary embodiment, as shown in more detailin FIG. 3, the second member 30 can have a substantially elongate shapewith first and second portions 30 a, 30 b. The first portion 30 a can beadapted to couple to a bone engaging element for mating the firstportion 30 a to a vertebra, e.g., the superior vertebra 60 s, and thesecond portion 30 b can form the extension rod 32 that is adapted toextend through the opening 22 i formed in the bearing element 22. Thefirst and second portions 30 a, 30 b can be coaxial with one another,but in an exemplary embodiment the first and second portions 30 a, 30 bare axially offset from one another. In particular, the axis A₁ of thefirst portion 30 a can be spaced a distance D apart from the axis A₂ ofthe second portion 30 b. While the distance can vary, in one exemplaryembodiment the distance D can be in the range of about 2 mm to 10 mm.Such a configuration will facilitate positioning of the second portion30 b, e.g., the extension rod 32, relative to the bearing element 22,and it can also allow the extension rod 32 to move relative to thebearing element 22 without abutting against or otherwise coming intocontact with the first portion 20 a of the first member 20.

As noted above, the first portion 30 a of the second member 30 can beadapted to couple to a bone engaging element to mate the first portion30 a to the superior vertebra 60 s. Accordingly, the first portion 30 acan have a variety of configurations depending on the type of boneengaging element used. In the exemplary embodiment shown in FIGS. 1A and1B, the bone engaging element is a bone screw 54 having a shank (notshown) that threads into the vertebra 60 s, and a U-shaped receivinghead 56. Accordingly, the first portion 30 a can be in the form of a rodthat is adapted to seat within the receiving head 56. A locking element,such as a set screw, can be used to lock the first portion 30 a withinthe receiving head 56, thereby mating the second member 30 to thevertebra 60 s. In another exemplary embodiment, the bone screw 54 can bea polyaxial bone screw such that the receiving head 54 is angularlyadjustable relative to the shank. Such a configuration will allow thesecond member 30 to be set at a desired position relative to the firstmember 20, and in particular the extension rod 32 can be positioned asdesired relative to the bearing element 22. The orientation of thesecond member 30 relative to the first member 20 can be used to controlmovement of the vertebrae 60 s, 60 i relative to one another, as will bediscussed in more detail below. A person skilled in the art willappreciate that a variety of other devices including, for example,offset connectors, can be used to mate the second member 30 to thevertebra.

The extension rod 32 of the second member 30 can also have a variety ofconfigurations, but it should be adapted to be extend through andslidably move relative to the bearing element 22. In the illustratedexemplary embodiment, the extension rod 32 has a substantiallycylindrical shape with a diameter d_(r) that is only slightly less thanan inner diameter d_(i) of the opening formed through the bearingelement 22.

The extension rod 32 can also include one or more physical stops formedthereon to limit movement thereof relative to the bearing element 22.While the physical stop(s) can have a variety of shapes and sizes, inthe illustrated exemplary embodiment the first portion 30 a and theextension rod 32 are separated by a substantially circular flange 34that forms a physical stop. The flange 34 can be adapted to abut againsta superior surface 20 s (FIG. 2A) of the first member 20 to limitpenetration of the extension rod 32 through the bearing element 22.Accordingly, the flange 34 preferably has an extent, e.g., a diameterd_(f), that is larger than the diameter d_(i) of the opening 22 i in thebearing element. The terminal end 32 t of the extension rod 32 can alsoinclude a flange formed thereon, as is further shown in FIG. 3, toprevent removal of the extension rod 32 from the bearing element 22.

The extension rod 32 can also include one or more compressive elementsdisposed there around and adapted to act as a cushion for preventinghard contact between the extension rod 32 and the bearing element 22, orthe second portion 20 b of the first member 20. As shown in FIG. 3, thecompressive element 36 can be in the form of a donut or similar shapedmember that is disposed around the extension rod 32. The compressiveelement 36 can be positioned adjacent to the flange 34, or it can bedisposed or formed on the terminal end 32 t of the extension rod 32 asshown. Alternatively, the flange on the terminal end 32 t can be formedfrom a compressive material, or it can include a compressive elementmated thereto or formed thereon. A person skilled in the art willappreciate that a variety of techniques can be used to control movementof and limit hard impact between the extension rod 32 and the bearingelement 22. A person skilled in the art will also appreciate that avariety of materials can be used to form a compressive element. By wayof non-limiting example, suitable materials include polymers, such aspolyurethane, silicone-urethane copolymer, polycarbonateurethane.Metallic springs can also be used.

In use, the implant 10 can replace and/or augment one or more of theposterior elements of the spine, including, for example, the facetjoints, the lamina, the posterior ligaments, and/or other features of apatient's spinal column. The particular configuration and use of theimplant 100 can, however, vary depending on the specific procedure beingperformed. For example, where a laminectomy is performed and the facetjoints are not removed, the implant can be used to reduce the load onthe facet joints. Where the facet joints are removed, it may benecessary to add an anti-rotation feature, as will be discussed in moredetail below, to prevent rotation of the bone screws relative to thevertebrae. Where the posterior ligaments are removed, it may bedesirable to use one or more compressive elements to facilitate controlof flexion of the vertebrae. The implant 10 can also be adapted tofunction with either a natural vertebral disc, or with an artificialdisc as previously discussed. Regardless, as noted above, the implant 10is preferably adapted to allow flexion, extension, and lateral bendingof the spine, while substantially restricting posterior-anterior shearand rotation of the spine. While an exemplary method of implanting onlyone posterior stabilizing implant 10 will be discussed, a person skilledin the art will appreciate that, in an exemplary embodiment, twoimplants 10, 10′ are implanted on opposed lateral sides of adjacentvertebrae. Moreover, any number of implants can be used to couplemultiple adjacent vertebrae depending on the needs of the patient.

One exemplary procedure can begin by implanting a bone screw 50 in theinferior vertebra 60 i, and implanting a bone screw 54 in the superiorvertebra 60 s. As shown in FIGS. 1A and 1B, the bone screws 50, 54 areimplanted on a lateral side of the vertebrae 60 s, 60 i to allow anotherimplant 10′ to be implanted on the opposed lateral side of the vertebrae60 s, 60 i. Once the bone screws 50, 54 are implanted, the first member20 can be coupled to bone screw 50 by positioning the articulatingsurface 26 of the first portion 20 a on the receiving head such that thecentral shaft of the bone screw 50 extends through the opening 24 in thefirst member 20. The locking nut 52 can then be loosely threaded ontothe central shaft of the bone screw 50 to loosely attach the firstmember 20 to the bone screw 50. The first member 20 can then beangularly adjusted as desired, and once properly positioning, thelocking nut 52 can be tightened to maintain the first member 20 in afixed position relative to the vertebra 60 i. The second member 30 canbe coupled to bone screw 54 by inserting the extension rod 32 throughthe bearing element 22 and positioning the first portion 30 a within thereceiving head 56 of the bone screw 54. The locking element, e.g., setscrew 58, can then be inserted into the receiving head 56 to looselymate the second member 30 to the vertebra 60 s. Where the bone screw 54is a polyaxial bone screw, the second member 30 can be angularlyadjusted by moving the receiving head 56. Once the second member 30 isproperly positioned, the set screw 58 can be fully tightened to maintainthe second member 30 in a fixed position relative to the vertebra 60 s.A person skilled in the art will appreciate that the bone screws 50, 54and the first and second members 20, 30 can be implanted and adjusted inany order. In one exemplary embodiment, the second member 30 ispositioned as desired and the first member 20 is then positioned asnecessary based on the positioning of the second member 30.

While not shown, where the implant 10 is used to replace the facetjoints, it may be desirable to include an anti-rotation feature toprevent rotation of the bone screws that are implanted in the superiorvertebra 60 s. While various anti-rotation techniques can be used, inone embodiment the bone screws can include spikes or other surfaceprotrusions formed on a proximal end of the shank or on the head of thescrews to prevent rotation thereof. In another embodiment, across-connector can be connected to and extend between the first portionof the second member of each implant, thereby preventing rotation of thebone screw mated thereto.

Once the implant 10 is coupled to the adjacent vertebrae 60 s, 60 i, theimplant 10 can control movement of the vertebrae 60 s, 60 i relative toone another. In particular, during movement of the spine, the bearingelement 22 rotates as the extension rod 32 slidably moves therethroughto control movement of the vertebrae 60 s, 60 i. Due to theconfiguration of the implant 10, the bearing element 22 and theextension rod 32 can also substantially prevent axial rotation of thevertebrae 60 s, 60 i relative to one another, and anterior-posteriorshearing can be substantially resisted. FIGS. 4A-4C illustrate thevertebrae 60 s, 60 i in a neutral position, and during flexion andextension. FIG. 4A illustrates the vertebrae 60 s, 60 i in a neutralposition, 60 i. FIG. 4B illustrates the vertebrae 60 s, 60 i duringextension, and as shown the extension rod 32 is fully inserted into thebearing element 22 such that the flange 34 abuts against the bearingelement 22. FIG. 4C illustrates flexion of the vertebrae 60 s, 60 i, andas shown the bearing element 22 is pivoted relative to the first member20 and the extension rod 32 is substantially withdrawn from the bearingelement 22 such that only the terminal end 32 t of the extension rod 32remains in the bearing element 22.

While the extension rod 32 can be positioned to be substantiallyparallel to the central axis X of the vertebrae 60 s, 60 i, theextension rod 32 can be positioned at a particular angle relative to thecentral axis X of the vertebrae 60 s, 60 i to control the movement ofthe vertebrae 60 s, 60 i. As shown in FIG. 4A, the position of theextension rod 32 relative to the vertebrae 60 s, 60 i is indicated byangle α, which is measured between a line perpendicular to the centralaxis X and the axis A₂ of the extension rod 32. In order to increaseflexion, the extension rod 32 can angled toward the central axis of thevertebrae 60 s, 60 i such that the angle α is less than 90°. At thisangle, the flange 34 will be positioned closer to the bearing element 22in the neutral position. As a result, when the vertebrae 60 s, 60 i movefrom the neutral position, shown in FIG. 4A, to the extended position,shown in FIG. 4B, the range of motion will be limited. Conversely, whenthe vertebrae 60 s, 60 i move from the neutral position to the flexedposition, shown in FIG. 4C, the range of motion will be greater. Inorder to decrease flexion, the extension rod 32 can angled away from thecentral axis of the vertebrae 60 s, 60 i such that the angle α isgreater than 90°. At this angle, the flange 34 will be spaced a greaterdistance apart from the bearing element 22 in the neutral position. As aresult, when the vertebrae 60 s, 60 i move from the neutral position,shown in FIG. 4A, to the extended position, shown in FIG. 4B, the rangeof motion will be increased. Conversely, when the vertebrae 60 s, 60 imove from the neutral position to the flexed position, shown in FIG. 4C,the range of motion will be decreased. Accordingly, the angle α of theextension rod 32 can be selected based on the desired range of motionduring flexion and extension. A person skilled in the art willappreciate that the angle α can vary depending on the desired result,but in an exemplary embodiment the angle α can be in the range of about60° to about 120°.

While not shown, the procedure can also include the step of placing asheath or protective member partially or fully around the implant 10 forpreventing tissue from growing on the implant 10 and into the bearingelement 22, and for preventing debris from migrating into the spinalcanal.

FIGS. 5A-8C illustrate another exemplary embodiment of a posteriorstabilizing implant 10. The implant 100 is somewhat similar to implant10, except that it has a bilateral configuration. In particular, ratherthan having two implants 10, 10′ positioned on opposed lateral sides oftwo adjacent vertebrae, implant 100 can be positioned along the mid-lineof the adjacent vertebrae to control movement of the vertebrae relativeto one another.

As shown in FIGS. 5A and 5B, the exemplary implant 100 generallyincludes a first member 120 that is adapted to couple to a firstvertebra, e.g., an inferior vertebrae 160 i, and that includes a bearingelement 122 disposed therein, and a second member 130 that is adapted tocouple to a second vertebrae, e.g., a superior vertebrae 160 s, and thathas an extension rod 132 formed thereon. While not shown, the first andsecond members 120, 130 can be reversed such that the first member 120is coupled to the superior vertebra 160 s and the second member 130 iscoupled to the inferior vertebra 160 i. In use, the bearing element 122is adapted to freely rotate relative to the first member 120, and theextension rod 132 is adapted to slidably extend through the bearingelement 122 to control movement of the adjacent vertebrae 160 s, 160 i,allowing flexion, extension, and lateral bending of the spine, whilesubstantially restricting posterior-anterior shear and rotation of thespine. While not shown, the first and second members 120, 130 can bereversed such that the first member 20 is coupled to the superiorvertebra 60 s and the second member 30 is coupled to the inferiorvertebra 60 i.

The first member 120 of the implant 100, which is shown in more detailin FIG. 6, can have a variety of configurations. In the illustratedexemplary embodiment, however, the first member 120 is substantiallyY-shaped and it includes a central portion 120 a having the bearingelement 122 disposed therein, and first and second arms 120 b, 120 cthat extend from the central portion 120 a and that are adapted to mateto a vertebra, e.g., the inferior vertebra 60 i. The central portion 120a and the first and second arms 120 b, 120 c can have a variety ofshapes and sizes, and the configuration can vary depending on theintended use. In the illustrated exemplary embodiment, the centralportion 120 a has a substantially planar cylindrical configuration suchthat it is adapted to seat the bearing element 122 therein, and thefirst and second arms 120 b, 120 c each extend distally and laterallyoutward from the central portion 120 a. Such a configuration allows thefirst and second arms 120 b, 120 c to mate to opposed lateral sides ofthe vertebra 160 i.

The first and second arms 120 b, 120 c can mate to the inferior vertebra160 i using a variety of techniques. In the illustrated exemplaryembodiment, the arms 120 b, 120 c are in the form of rods having agenerally elongate, substantially cylindrical configuration. This allowseach arm 120 b, 120 c to be received within a receiving head of a boneengaging element. In the embodiment shown in FIGS. 5A and 5B, the boneengaging elements are bone screws 150 a, 150 b that are implanted onopposed lateral sides of the inferior vertebra 160 i. As previouslydescribed above with respect to FIGS. 1A and 1B, the bone screws 150 a,150 b can include a U-shaped head that is adapted to seat an arm 120 b,120 c, and a locking element, such as a set screw 152 a, 152 b can beused to lock the arms 120 b, 120 c to the bone screws 150 a, 150 b. Thereceiving head of each bone screw 150 a, 150 b can also be polyaxiallymovable relative to the threaded shank (not shown) of the bone screw 150a, 150 b to allow the first member 120 to be angularly adjustablerelative to the vertebra 160 i. Such a configuration allows the bearingelement 122 to be positioned as desired, as will be discussed in moredetail below.

As noted above, the first member 120 also includes a bearing element 122disposed therein. The bearing element 122 can have a configuration thatis the same as or similar to the configuration previously described withrespect to bearing element 22 shown in FIGS. 1A-2. In particular, thebearing element 122 can be freely rotatably disposed within a sphericalrecess formed in the central portion 120 a of the first member 120, orit can be freely rotatably disposed within an insert 127 that isdisposed within the central portion 120 a of the first member 120, asshown in FIG. 6. As was also previously described, the bearing element122 can be a standard ball bearing that includes an opening 122 i formedtherethrough for slidably receiving the extension rod 132 on the secondmember 130. The bearing element 122, the recess 128 formed within theinsert 127 for seating the bearing element 122, and/or the opening 122 iformed through the bearing element 122 can also include a coating toreduce friction and reduce wear.

The second member 130 of the implant 10 can also have a variety ofconfigurations, but in an exemplary embodiment, as shown in more detailin FIG. 7, the second member 130 can be substantially Y-shaped with acentral portion 130 a having first and second arms 130 b, 130 cextending laterally from opposed sides thereof. The extension rod 132can also extend from the central portion 130 a. The particular angle ofeach arms 130 b, 130 c relative to the extension rod 132 can varydepending on the intended use, but in an exemplary embodiment 130 b, 130c that arms have a configuration that allows each arm 130 b, 130 c tomate to opposed lateral sides of a vertebra, e.g., the superior vertebra160 s.

Each arm 130 b, 130 c can be mated to the vertebra 160 s using a varietyof techniques, however in an exemplary embodiment each arm 130 b, 130 cis in the form of a rod having a substantially elongate cylindricalshape such that the arms 130 b, 130 c can mate to a receiving head of abone engaging element, such as bone screws 150 c and 150 d as shown. Aspreviously described, the bone screws 150 c, 150 d can be polyaxial bonescrews to allow the position of the second member 130 to be angularlyadjusted as desired, and in particular to allow the extension rod 132 tobe positioned as desired relative to the bearing element 122. A lockingelement, such as a set screw 152 c, 152 d can be used to lock the arms130 b, 130 c to the bone screws 150 c, 150 d.

The extension rod 132 of the second member 130 can also have a varietyof configurations, but in an exemplary embodiment the extension rod 132is similar to extension rod 22 previously described with respect toFIGS. 1A, 1B, and 3. In particular, the extension rod 132 should beadapted to be extend through and slidably move relative to the bearingelement 122. In the illustrated exemplary embodiment, the extension rod32 has a substantially cylindrical shape with a diameter D_(r) that isonly slightly less than an inner diameter D_(i) of the opening formedthrough the bearing element 122.

As previously described with respect to FIG. 3, the extension rod 132can also include a physical stop formed thereon to limit movementthereof relative to the bearing element 122. While the physical stop canhave a variety of shapes and sizes, in the illustrated exemplaryembodiment the central portion 130 a has a substantially cylindricalshape with a surface 131 that is adapted to abut against the bearingelement 122 to limit penetration of the extension rod 132 through thebearing element 122. Accordingly, the surface 131 preferably has anextent, e.g., a diameter D_(f), that is larger than the diameter D_(i)of the opening 122 i in the bearing element.

The extension rod 132 can also include one or more compressive elementsdisposed there around, as previously described with respect to FIG. 3,for providing a cushion to substantially prevent hard contact betweenthe extension rod 132 and the bearing element 122, or the centralportion 120 a of the first member 120. The compressive element(s) (notshown) can be in the form of a donut or similar shaped member that isdisposed around the extension rod 132. The compressive element can bepositioned adjacent to surface 131, and/or it can be disposed or formedon the terminal end 132 t of the extension rod 32. The terminal end 132t can also include a stop surface or flange 136 formed thereon, as shownin phantom in FIG. 7, to prevent the extension rod 132 from being fullywithdrawn from the bearing element 122, and optionally to retain acompressive element on the extension rod 132. Alternatively, flange 136can be formed from a compressive material, or it can include acompressive element mated thereto or formed thereon. A person skilled inthe art will appreciate that a variety of techniques can be used tocontrol movement of and limit hard impact between the extension rod 132and the bearing element 122. A person skilled in the art will alsoappreciate that a variety of materials can be used to form a compressiveelement.

While not shown, in another exemplary embodiment the extension rod 132can be adjustable relative to the first and second arms 130 b, 130 c.For example, the extension rod 132 can be rotatably mated to the centralportion 130 a, and the central portion 130 a can include a lockingmechanism that is adapted to lock the extension rod 132 in a desiredfixed position. Such a configuration is particularly desirable where thebone screws 150 c, 150 d used to attach the arms 130 b, 130 c to thevertebra 160 s are not polyaxial. The extension rod 132 can thus bepositioned at a desired angle relative to the vertebra 160 s, and thenlocked in place to maintain it at the desired angular position. A personskilled in the art will appreciate that a variety of other techniquescan be used to allow the extension rod 132 to be adjusted relative tothe remainder of the second member 130.

In use, the implant 100 can replace and/or augment one or more of theposterior elements of the spine, including, for example, the facetjoints, the lamina, the posterior ligaments, and/or other features of apatient's spinal column. The implant 100 can also be adapted to functionwith either a natural vertebral disc, or with an artificial disc aspreviously discussed. Regardless, as noted above, the implant 100 ispreferably adapted to allow flexion, extension, and lateral bending ofthe spine, while substantially restricting posterior-anterior shear androtation of the spine. The particular configuration and use of theimplant 100 can, however, vary depending on the specific procedure beingperformed. For example, where a laminectomy is performed and the facetjoints are not removed, the implant can be used to reduce the load onthe facet joints. Where the facet joints are removed, it may benecessary to add an anti-rotation feature as previously discussed toprevent rotation of the bone screws relative to the vertebrae. Where theposterior ligaments are removed, it may be desirable to use one or morecompressive elements to facilitate control of flexion of the vertebrae.

One exemplary procedure can begin by implanting two bone screws 150 a,150 b in the inferior vertebra 160 i, and implanting two bone screws 150c, 150 d in the superior vertebra 160 s. As shown in FIGS. 5A and 5B,the bone screws 150 a, 150 b, 150 c, 150 d are implanted on opposedlateral sides of the vertebrae 160 s, 160 i. Once the bone screws 150 a,150 b, 150 c, 150 d are implanted, the first member 120 can be coupledto bone screws 150 a, 150 b by positioning the arms 120 b, 120 c in thereceiving head of the bone screws 150 a, 150 b such that the centralportion 120 a is positioned toward the superior vertebra 160 s. The setscrews 152 a, 152 b can then be loosely threaded onto the receivingheads of the bone screws 150 a, 150 b to loosely attach the first member120 to the bone screws 150 a, 150 b. Where the bone screws 150 a, 150 bare polyaxial bone screws, the first member 120 can be angularlyadjusted by moving the receiving heads of the screws 150 a, 150 b. Onceproperly positioned, the set screws 152 a, 150 s can be tightened tomaintain the first member 120 in a fixed position relative to thevertebra 160 i. As previously described, the extension rod 132 can bepositioned at a desired angle relative to the vertebrae 160 s, 160 i.The second member 130 can similarly be coupled to two bone screws 150 c,150 d by inserting the extension rod 132 through the bearing element122, and positioning the arms 130 b, 130 c within the receiving heads ofthe bone screws 150 c, 150 d. The set screws 152 c, 152 d can be looselymated to the receiving heads to retain the arms 130 b, 130 c therein.Where the bone screws 150 c, 150 d are polyaxial bone screws, the secondmember 130 can be angularly adjusted by moving the receiving heads ofthe screws 150 c, 150 d. Once the second member 130 is properlypositioned, the set screws 152 c, 152 d can be fully tightened tomaintain the second member 130 in a fixed position relative to thevertebra 160 s. A person skilled in the art will appreciate that thebone screws 150 a, 150 b, 150 c, 150 d and the first and second members120, 130 can be implanted and adjusted in any order. In one exemplaryembodiment, the second member 130 is positioned as desired and the firstmember 120 is then positioned as necessary based on the positioning ofthe second member 130.

Once the implant 100 is coupled to the adjacent vertebrae 160 s, 160 i,the implant 100 can control movement of the vertebrae 160 s, 160 irelative to one another. In particular, during movement of the spine,the bearing element 122 rotates as the extension rod 132 slidably movestherethrough to control movement of the vertebrae 160 s, 160 i. Due tothe configuration of the implant 100, the bearing element 122 and theextension rod 132 can also substantially prevent axial rotation of thevertebrae 160 s, 160 i relative to one another, and anterior-posteriorshearing can be substantially resisted. FIGS. 8A-8C illustrate thevertebrae 160 s, 160 i in a neutral position, and during flexion andextension. FIG. 8A illustrates the vertebrae 160 s, 160 i in a neutralposition, and as shown the extension rod 132 is substantially parallelto the central axis Y of the vertebrae 160 s, 160 i. FIG. 8B illustratesthe vertebrae 160 s, 160 i during extension, and as shown the extensionrod 132 is fully inserted into the bearing element 122 such that surface131 abuts against the bearing element 122. FIG. 8C illustrates flexionof the vertebrae 160 s, 160 i, and as shown the bearing element 122 ispivoted relative to the first member 120 and the extension rod 132 issubstantially withdrawn from the bearing element 122 such that only theterminal end 132 t of the extension rod 132 remains in the bearingelement 122.

While not shown, the procedure can also include the step of placing asheath or protective member partially or fully around the implant 100for preventing tissue from growing on the implant 100 and into thebearing element 122, and for preventing debris from migrating into thespinal canal.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

1. A method for stabilizing the posterior element in adjacent vertebrae,comprising: coupling a first portion of a first member to a firstvertebra and a second member to a second vertebra such that an extensionrod on the second member extends through a bearing element disposedwithin a second portion of the first member and such that the extensionrod extends out of opposite ends of the second portion, the bearingelement being rotatably disposed within the first member to therebyallow flexion, extension, and lateral bending of the first and secondvertebrae relative to one another, the extension rod sliding freelythrough the bearing element during movement of the first and secondvertebrae, and the second member including a stop formed thereon forlimiting movement of the second member relative to the bearing element;wherein the first member is coupled to the first vertebra by implantinga bone engaging member in the first vertebra and mating the firstportion of the first member to the bone engaging member, and wherein thesecond member is coupled to the second vertebra by implanting a boneengaging member in the second vertebra and mating a portion of thesecond member to the bone engaging member; and wherein the first memberis substantially L-shaped with the first portion being adapted to mateto the bone engaging element, and the second portion having the bearingelement rotatably disposed therein, and the second member comprises asubstantially elongate member having a first portion that is adapted tomate to the bone engaging element and a second portion that is adaptedto be disposed through the bearing element.
 2. The method of claim 1,further comprising positioning the extension rod at a predeterminedangle relative to a central axis of the first and second vertebrae. 3.The method of claim 2, wherein the angle is in the range of about 60° toabout 120°.
 4. The method of claim 1, wherein the stop is formed on thesecond member between the first and second portions, the stop beingadapted to limit movement of the second portion relative to the bearingelement.
 5. The method of claim 1, wherein the first and second portionsof the second member are axially offset from one another.
 6. A methodfor stabilizing the posterior element in adjacent vertebrae, comprising:implanting a first bone engaging member in a first vertebra; coupling afirst member to the first bone engaging member; implanting a second boneengaging member in a second vertebra; coupling a first extension rod ofa second member to the second bone engaging member; and positioning asecond extension rod axially offset from the first extension rod of thesecond member through a bearing element such that the second portion ofthe second member extends out of opposite ends of the bearing element,the bearing element being rotatably disposed within the first member toallow movement of the first and second vertebrae relative to oneanother, and the first and second extension rods extending from a stopdisposed therebetween that limits slidable movement of the secondextension rod through the bearing element.
 7. The method of claim 6,wherein the first and second members allow flexion, extension, andlateral bending of the first and second vertebra relative to oneanother.
 8. The method of claim 7, wherein the first and second memberssubstantially restrict posterior-anterior shear and rotation of thefirst and second vertebra relative to one another.
 9. The method ofclaim 6, wherein the second portion of the second member slides freelythrough the bearing element during movement of the first and secondvertebrae.